Ocular Surface Disease Research Articles

Label-free quantitative imaging of conjunctival goblet cells.

To introduce and validate quantitative oblique back-illumination microscopy (qOBM) as a label-free, high-contrast imaging technique for visualizing conjunctival goblet cells (GCs) and assessing their functional changes. qOBM was developed in conjunction with moxifloxacin-based fluorescence microscopy (MBFM), which was used for validating GC imaging. Initial validation was conducted with polystyrene beads, followed by testing on normal mouse conjunctiva under both ex-vivo and in-vivo conditions. Longitudinal qOBM imaging was performed on ex-vivo mouse conjunctiva exposed to hyperosmotic stress (induced by 1000 mOsm/kg NaCl solution) and normal saline (300 mOsm/kg balanced salt solution, BSS). Imaging was conducted at baseline and at 15- and 30-minute instillation. Results were compared to those of MBFM and periodic acid-Schiff (PAS) staining. A similar longitudinal study was performed in-vivo, and the outcomes were analyzed. qOBM accurately imaged polystyrene beads, with measured phase delays matching theoretical predictions. In normal mouse conjunctiva, qOBM visualized GCs in high contrast, confirmed by MBFM, and the average phase delay was 0.59 ± 0.25 radians. Under hyperosmotic stress, qOBM detected a significant reduction in GC phase delays, decreasing to levels of the surrounding tissue (-0.07 ± 0.14 radians). In normal conditions, no notable changes were observed in GCs. In-vivo imaging results were consistent with ex-vivo findings. Statistical analysis further characterized these changes. The results were consistent with MBFM and PAS staining. qOBM is a high-contrast, label-free imaging modality that enables the functional assessment of GCs. This technique holds significant potential for advancing research and clinical diagnostics related to ocular surface diseases.

Contact Lenses in Therapeutic Care: A Comprehensive Review of Past Innovations, Present Applications, and Future Directions.

Contact lenses have become integral tools in the realm of ocular therapeutics, extending beyond their primary function of refractive correction to encompass a diverse array of therapeutic applications. This review explores the evolving role of contact lenses in managing various ocular conditions, highlighting their efficacy in enhancing patient outcomes. Initially developed to correct refractive errors, contact lenses now serve as effective vehicles for delivering medications directly to the ocular surface, offering targeted treatment for conditions such as dry eye syndrome and corneal ulcers. Their ability to provide sustained moisture and facilitate drug absorption makes them indispensable in promoting corneal healing and managing chronic ocular surface diseases. Specialized contact lenses designed for irregular corneas, such as those affected by keratoconus, provide both optical correction and structural support, significantly improving visual acuity and patient comfort. Additionally, orthokeratology lenses have shown promise in controlling myopia progression in children by reshaping the cornea overnight, thereby reducing reliance on corrective eyewear during waking hours. In post-surgical settings, therapeutic contact lenses aid in epithelial regeneration and minimize discomfort, accelerating recovery and improving surgical outcomes. They also play a crucial role in protecting the cornea from external irritants and promoting a stable tear film, crucial for maintaining ocular health. Looking ahead, ongoing advancements in contact lens materials and designs promise further innovation in ocular therapeutics, paving the way for personalized treatment strategies and improved patient care. As such, contact lenses continue to evolve as essential therapeutic tools, offering tailored solutions for a spectrum of ocular conditions and contributing to enhanced quality of life for patients worldwide.

Topographic corneal changes in children with moderate to severe blepharokeratoconjunctivitis.

Purpose To determine the corneal topographic characteristics of children with blepharokeratoconjunctivitis (BKC), a chronic inflammatory ocular surface disease involving the lid margin, conjunctiva, and cornea. Methods The corneal topography of 21 children diagnosed with BKC between March 2008 and June 2019 at a single institution were reviewed retrospectively. Pachymetry and asymmetry indices were also analyzed. Results Mean flat keratometry (K1), steep keratometry (K2), maximum keratometry (Kmax), and topographic astigmatism (TA) were 42.61 ± 2.63 D, 46.00 ± 3.17 D, 51.00 ± 5.29 D, and 3.39 ± 2.60 D, respectively. Mean central corneal thickness (CCT) was 528.8 ± 72.2 μm; mean thinnest point (TP) was 487.00 ± 88.28 μm; 47% of eyes had a TP of <500 μm. Compared with previously published pediatric normative values, K2, Kmax, and TA were significantly higher (46.00 ± 3.17 vs 45.16 ± 0.27, 51.00 ± 5.29 vs 45.76 ± 0.28, and 3.38 ± 2.48 vs 2.81 ± 0.19 [P < 0.0001]), whereas mean CCT and TP were significantly lower in the BKC group. 72.2% of cases fulfilled the Rabinowitz diagnostic criteria for ectasia: 67% had a Kmax >47.2 D and 31% had an inferior-superior asymmetry value >1.2 D. Using topography-derived indices comparing the superior and inferior corneal characteristics, the index of height decentration, index of surface variance, and index of vertical asymmetry were found to be abnormal in 83%, 69%, and 64% of cases, respectively. Conclusions Children with moderate-to-severe BKC may present with significant topographic corneal changes that can mimic corneal ectasia. Corneal topography could be an important tool in evaluating corneal involvement and explaining reduced visual function due to refractive changes.

Is There a Difference Between Seropositive and Seronegative Sjögren Disease Dry Eye?

The study aims to compare dry eye disease (DED) prevalence and severity between seropositive and seronegative Sjögren disease (SjD). Prospective, consecutive, comparative cross-sectional cohort study. A total of 160 eyes of 80 patients with SjD by The American College of Rheumatology and the European League Against Rheumatism 2016 criteria were included: 55 seropositive and 25 seronegative SjD. Associated SjD was excluded. Patients had dry eye tests performed. Generalized estimating equations were used to account for intereye correlation of the same participant. Mean age was 52.2 ± 12.7, 96.3% were women, no differences were observed between groups (P > 0.05). Seronegative SjD had positive minor salivary gland biopsy more often (100% vs. 82%, P = 0.024), but with lower focus score (2.0 ± 1.2 vs. 4.1 ± 3.5, P = 0.006) than seropositive SjD group. DED prevalence was similar in seropositive and seronegative SjD (92.7% and 84%; P = 0.088). Only noninvasive break-up time (NIBUT) average was significantly reduced in seropositive SjD (6.6 ± 3.2 vs. 8.8 ± 2.4, P = 0.011), and the rest of the evaluated DED tests were not significant. In the seropositive group, nonstatistically significant trends toward more severe DED signs, including matrix metalloproteinase-9, osmolarity, Schirmer I without anesthesia, fluorescein tear break-up time, NIBUT first, and Sicca Ocular Staining Score, were observed. Both groups were highly symptomatic in ocular surface disease index score (43 ± 23 vs. 46 ± 30, P = 0.779) and had a reduction in quality of life in National Eye Institute visual health questionnaire-25 test (72 ± 21 vs. 70 ± 24, P = 0.650). Patients with seropositive SjD showed significantly reduced NIBUT and a trend of more severe DED signs. Patients with seronegative and seropositive SjD were similarly highly symptomatic, experienced important reductions in vision-related quality of life, and had similar DED prevalence.

Efficacy and safety of preservative-free anti-glaucomatous eye drops (dorzolamide/timolol) in ocular hypertension and/or glaucoma.

This study evaluated the efficacy, safety, and tolerability of a single-dose, preservative-free (PF) Dorzolamide/Timolol combination (Twinzol-SDU). A 3-month single-arm, multicenter, prospective cohort study was conducted in Egypt between January 2021 and October 2022 on previously diagnosed and controlled patients with ocular hypertension and/or glaucoma. Efficacy was assessed using the change in intraocular pressure (IOP) after 6 and 12weeks. Safety was identified through the change in the incidence of ocular side effects, ocular surface disease index (OSDI) scores and grades, and Time Break-Up time (TBUT). A total of 382 patients were enrolled in the analysis. After the three-month period of therapy, a significant reduction in IOP was seen (mean change: -1.9, P < 0.001) after switching to PF Dorzolamide/Timolol combination. The rate of ocular abrasion decreased significantly from 30.6% to 1.3% (P < 0.001). The rate of normal aqueous tear production increased from 24.1% to reach 79.4% (P < 0.001). The OSDI scores decreased significantly throughout the study period, with a median score decreased from 41.7 (21.7) to 12.5 (12.5) (P < 0.001). Mild OSDI grades significantly increased from the baseline of 12.6% to reach 24.7%. Moderate OSDI grade decreased at the same rate, from 12.8% to 11.1%. The number of patients with severe OSDI grade substantially decreased from 64.4% to 4.5%, with a P < 0.001. TBUT increased from 9 (3.7) seconds to reach and 12.3 (4) seconds after 12weeks of treatment (P < 0.001). Generally, the PF dorzolamide/timolol combination was associated with a significant reduction in IOP and tolerability among glaucoma patients.

Assessing the possibility of using large language models in ocular surface diseases.

To assess the possibility of using different large language models (LLMs) in ocular surface diseases by selecting five different LLMS to test their accuracy in answering specialized questions related to ocular surface diseases: ChatGPT-4, ChatGPT-3.5, Claude 2, PaLM2, and SenseNova. A group of experienced ophthalmology professors were asked to develop a 100-question single-choice question on ocular surface diseases designed to assess the performance of LLMs and human participants in answering ophthalmology specialty exam questions. The exam includes questions on the following topics: keratitis disease (20 questions), keratoconus, keratomalaciac, corneal dystrophy, corneal degeneration, erosive corneal ulcers, and corneal lesions associated with systemic diseases (20 questions), conjunctivitis disease (20 questions), trachoma, pterygoid and conjunctival tumor diseases (20 questions), and dry eye disease (20 questions). Then the total score of each LLMs and compared their mean score, mean correlation, variance, and confidence were calculated. GPT-4 exhibited the highest performance in terms of LLMs. Comparing the average scores of the LLMs group with the four human groups, chief physician, attending physician, regular trainee, and graduate student, it was found that except for ChatGPT-4, the total score of the rest of the LLMs is lower than that of the graduate student group, which had the lowest score in the human group. Both ChatGPT-4 and PaLM2 were more likely to give exact and correct answers, giving very little chance of an incorrect answer. ChatGPT-4 showed higher credibility when answering questions, with a success rate of 59%, but gave the wrong answer to the question 28% of the time. GPT-4 model exhibits excellent performance in both answer relevance and confidence. PaLM2 shows a positive correlation (up to 0.8) in terms of answer accuracy during the exam. In terms of answer confidence, PaLM2 is second only to GPT4 and surpasses Claude 2, SenseNova, and GPT-3.5. Despite the fact that ocular surface disease is a highly specialized discipline, GPT-4 still exhibits superior performance, suggesting that its potential and ability to be applied in this field is enormous, perhaps with the potential to be a valuable resource for medical students and clinicians in the future.

A prospective self-controlled study on the alterations of the ocular surface and conjunctival transcriptomic profile associated with prolonged exposure to video display terminals.

To assess the impact of prolonged and intense exposure to video display terminals (VDTs) on ocular surface homeostasis. 30 subjects limited daily VDT usage to less than 3h for one week, then extended usage to more than 8h/day for the next three weeks. Ocular symptoms and signs were evaluated weekly using the Ocular Surface Disease Index (OSDI) questionnaire and clinical examinations. Eyelid margins and meibomian glands were examined, and ocular surface samples were collected for transcriptomic analysis. Average daily VDT time increased from 2.55±0.46h initially to 11.17±2.45, 11.75±2.63, and 10.89±2.41h over three weeks. The dry eye diagnosis rate rose from 6.67% to 51.67%. Total OSDI score (P=0.008), symptoms score (P=0.014), and visual function score (P=0.002) significantly increased. Mean fluorescein break-up time (FBUT) decreased from 6.46s to 3.08s. Corneal fluorescein staining (CFS) score (P<0.001) and lissamine green conjunctival staining (LCjs) score (P=0.036) worsened. Ocular redness index (RI) increased at 1 week and 3 weeks (P=0.007, P=0.001). Telangiectasia scores of both upper and lower eyelid margins increased at 3 weeks (P=0.002, P<0.001). Meibomian gland orifice blockage worsened (P=0.014, P=0.002). Transcriptomic analysis revealed dynamic alterations in ocular surface gene expression, including inflammatory and hormonal responses. MUC5AC and TFF1 genes showed negative correlations with OSDI and conjunctival staining score, respectively. Prolonged VDT exposure deteriorates ocular surface symptoms and signs, with significant inflammatory responses and hormonal activity indicating an imbalance in ocular surface homeostasis.

Modern Biomarkers for Early Diagnosis of Ocular Surface Disease in Type 1 Diabetes. A Pilot Study

Modern Biomarkers for Early Diagnosis of Ocular Surface Disease in Type 1 Diabetes. A Pilot Study

Cohesin Complex Interacting with Promoters of MMP Genes for in Pterygium Occurrence

Purpose Pterygium is a common ocular surface disease characterized by a high recurrence rate and unknown etiology. Methods In this study, we investigated the upregulation of matrix metalloproteinase genes, including MMP1, MMP2, MMP3, MMP7, MMP9, MMP11, MMP12, MMP13, MMP23B, and MMP28, in pterygium tissue using RNA sequencing, Western blotting, and immunohistochemistry. Results Employing the MEME tool, we identified a conserved DNA motif within the promoter regions of these matrix metalloproteinase genes. Mass spectrometry analysis revealed an interaction between the cohesin complex and this motif. Disrupting the cohesin complex through RNA interference of RAD21 cohesin complex component or structural maintenance of chromosomes 3 in primary pterygial fibroblasts led to decreased matrix metalloproteinase gene expression and reduced recruitment of twist family bHLH transcription factor 1 and transcription factor 4 to matrix metalloproteinase gene promoters. Conclusion Overall, our findings suggest a novel epigenetic mechanism regulating matrix metalloproteinase transcription in pterygium.

Multicomponent Dietary Supplementation: Impact on Tear Secretion and Ocular Surface Inflammation in Dry Eye Syndrome Patients.

Dry eye syndrome (DES) is a prevalent ocular condition characterized by tear film instability, inflammation, and discomfort, affecting millions worldwide. DES is related to oxidative stress imbalance and ocular surface inflammation, which are important factors in the development of the condition. Recent studies have demonstrated that fish oil, lutein, and zeaxanthin possess anti-inflammatory and antioxidant properties. This study investigated the efficacy of a multicomponent dietary supplement in improving tear secretion and mitigating ocular surface inflammation in patients with DES. It was an open-label intervention trial. In total, 52 participants were randomly assigned to control (n = 23) and supplement (45 mg/day eicosapentaenoic acid, 30 mg/day docosahexaenoic acid, 30 mg/day lutein, and 1.8 mg/day zeaxanthin; n = 29) groups for 12 weeks. The participants were evaluated using Schirmer's test and the ocular surface disease index (OSDI) as ocular surface parameters. Moreover, blood or tear oxidative stress, antioxidant capacities, and tear inflammatory indicators were measured at weeks 0 and 12. The results indicated a significant increase in tear secretion and a significant reduction in OSDI scores in the supplement group. Additionally, inflammatory markers, such as interleukin (IL)-6 and IL-8, significantly decreased after the intervention. However, the OSDI of the supplement group significantly improved by 6.60 points (β = -6.60, p = 0.01). These findings support the potential of targeted nutritional supplementation as a safe and effective strategy for alleviating DES symptoms, offering an alternative to conventional treatments that exclusively focus on symptom management. This study highlights the role of specific nutrients in modulating tear production and inflammation, thereby providing a foundation for dietary approaches to DES treatment. Future research should explore the long-term benefits of such interventions and their impact on overall ocular health.

Clinical Efficacy of Rebamipide Eyedrops in Patients with Sjögren’s Syndrome Accompanied by Meibomian Gland Dysfunction

Purpose: To investigate the clinical efficacy of rebamipide eyedrops in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome.Methods: The study included 50 patients with Sjögren’s syndrome accompanied by MGD treated with 0.05% (w/v) cyclosporine and 0.15% (w/v) sodium hyaluronate eyedrops. They were divided into two groups: 25 who added rebamipide eyedrops to their existing treatments and a control group of 25 whose treatments did not change. We evaluated the tear breakup time, the Schirmer test and conjunctival staining scores, meibomian gland quality and function, and eyelid margin irregularity before prescribing rebamipide eyedrops and 1 and 3 months after prescription. Additionally, before eyedrops use and 3 months later, meibographic scores were assessed via imaging of the meibomian gland and ocular surface disease index values also were assessed.Results: The rebamipide group exhibited significant improvements in the tear breakup time, conjunctival staining score, and ocular surface disease index compared to before treatment (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). However, the Schirmer test result, meibomian gland quality and function, and eyelid margin irregularity did not differ between either groups before or after treatment. After 3 months of eyedrop use, the rebamipide group exhibited a significantly higher tear breakup time (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) and Schirmer test score (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) than the control group (&lt;i&gt;p&lt;/i&gt; = 0.01), and significantly lower ocular surface disease index and conjunctival staining scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.01).Conclusions: Addition of rebamipide eyedrops to the conventional treatment of patients with Sjögren’s syndrome accompanied by MGD effectively improves dry eye symptoms and the ocular surface parameters.

Intense Pulsed Light in the Treatment of Dry Eye and Meibomian Gland Dysfunction in Patients With Chronic Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of dry eye disease and meibomian gland dysfunction associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. This prospective noncomparative interventional study included 29 patients (58 eyes) who underwent 3 sessions of IPL and MGX at 2-week intervals. Subjective symptoms (ocular surface disease index score) and objective dry eye tests: matrix metalloproteinase 9, tear meniscus height, bulbar redness score, tear film lipid layer thickness (LLT), Schirmer I test, conjunctival and corneal staining, meibomian gland loss, MGX score [meibomian gland score (MGS)], and tear break-up time were assessed at the baseline and after 4, 8, and 12 weeks. Twenty-nine individuals (57 eyes) were included in this analysis. The ocular surface disease index score decreased significantly from 60.07 ± 23.34 (baseline) to 38.36 ± 22.39 (after 90 days) (P < 0.01). The fluorescein and lissamine green staining scores, MGS, and LLT improved significantly (P < 0.01). In contrast, there were no significant changes in the tear meniscus height values, matrix metalloproteinase 9 positivity, bulbar redness score, Schirmer test, meibography of the superior and inferior eyelids, and tear break-up time. Ocular or skin complications were not observed. Three IPL therapy sessions followed by MGX seemed to be safe and effective in treating dry eye disease and meibomian gland dysfunction, improving vision-related quality of life, dry eye symptoms, and ocular surface signs, such as corneal and conjunctival staining scores, MGS, and LLT after 90 days in patients with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

Dry eye post-cataract surgery: a systematic review and meta-analysis

Dry eye post-cataract surgery: a systematic review and meta-analysis

Could Nocturnal Chronic Hypoxia Cause Ocular Surface Symptoms by Affecting Limbal Epithelial Cells in Patients With Obstructive Sleep Apnea?

To investigate the effect of nocturnal chronic hypoxia on the thickness changes of the corneal limbal epithelial area that provides regeneration of the corneal epithelium and ocular surface evaluation parameters in patients with obstructive sleep apnea (OSA). All patients diagnosed with OSA and the control group underwent a complete ophthalmological examination, including slit-lamp examination and funduscopy. Tear break-up time, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and anterior segment optical coherence tomography were performed with fluorescein sterile strip for ocular surface evaluation. Oxygenation levels of patients during night sleep were different between mild-severe and moderate-severe groups. The Ocular Surface Disease Index results were statistically significantly different between the severe OSA group and the mild OSA group, and between the control group and all other OSA groups (P < 0.05). The limbal epithelial thickness (LET) value was found to be lower in the moderate OSA group than in the mild OSA group and the control group and was statistically significantly higher than in the severe OSA group. In the severe OSA group, the LET value was found to be statistically significantly lower than all other groups (P < 0.05). In the literature, there is no study evaluating the effect of prolonged hypoxia on limbus epithelium as in patients with OSA. In this study, LET was measured to be statistically significantly thinner as the severity of OSA increased. Considering these results, it can be concluded that the proliferation of limbal stem cells is reduced in prolonged hypoxia.

Climate change and ocular surface diseases

The ocular surface is directly exposed to environmental influences. Noxae that have already been identified for the ocular surface are heat, air dryness, pollutant gases, fine dust particles and ultraviolet radiation. The current literature was used to investigate the relationship between frequent ocular surface diseases and various environmental factors and to analyze their development over the years. Epidemiological studies on dry eye disease and allergic conjunctivitis have shown an increase in the incidences in recent years. Environmental pollutants have been identified as disease triggers. In addition, the prolonged pollen season and increased pollen concentrations are also risk factors. There is also ahigher prevalence of pterygium in population groups with high UV exposure. Other diseases with potential environmental pathogenesis are acute photokeratitis, photoconjunctivitis and malignant melanoma of the conjunctiva. For ocular surface diseases, large epidemiological cohorts have shown climate-related increases in the incidence. Afurther increase in environmentally associated noxious substances can be expected in the coming decades. In addition to measures to mitigate climate change, the underlying mechanisms of disease development and new approaches to prevention and treatment, such as room humidification, air filters or contact lenses with UV filters, should be investigated.

A framework for the simulation of individual glycan coordinates to analyze spatial relationships within the glycocalyx.

The glycocalyx is a dense and dynamic layer of glycosylated species that covers every cell in the human body. It plays crucial roles in various cellular processes in health and disease, such as cancer immune evasion, cancer immune therapy, blastocyst implantation, and functional attenuation of membrane protein diffusion. In addition, alterations in glycocalyx structure may play an important role in ocular surface diseases, e.g., dry eye disease. Despite the emerging importance of the glycocalyx, various aspects of its functional organization remain elusive to date. A central reason for this elusiveness is the nanoscale dimension of the glycocalyx in conjunction with its high structural complexity, which is not accessible to observation with conventional light microscopy. Recent advances in super-resolution microscopy have enabled resolutions down to the single-digit nanometer range. In order to fully leverage the potential of these novel methods, computational frameworks that allow for contextualization of the resulting experimental data are required. Here, we present a simulation-based approach to analyze spatial relationships of glycan components on the cell membrane based on known geometrical parameters. We focus on sialic acids in this work, but the technique can be adapted to any glycan component of interest. By integrating data from mass spectrometry and quantitative biological studies, these simulations aim to model possible experimental outcomes, which can then be used for further analysis, such as spatial point statistics. Importantly, we include various experimental considerations, such as labeling and detection efficiency. This approach may contribute to establishing a new standard of connection between geometrical and molecular-resolution data in service of advancing our understanding of the functional role of the glycocalyx in biology as well as its clinical potential.

Comparing the corneal temperature of dry eyes with that of normal eyes via high-resolution infrared thermography.

This study compares the corneal temperature in dry eyes with normal eyes via high-resolution infrared thermography. A total of 86 participants were enrolled, with 40 and 46 participants in the dry eye disease (DED) and control groups, respectively. All participants underwent non-invasive breakup time (NIBUT) measurement, an Ocular Surface Disease Index (OSDI) questionnaire and ocular thermography. In the DED group, the mean initial central corneal temperature (initial CCT) is 33.25 ± 0.66°C, the tenth-second central corneal temperature (10s-CCT) is 32.47 ± 0.84°C, and the mean change in central corneal temperature measured within 10 s (change in CCT within 10 s) is 0.78 ± 0.30°C. For the controls, the initial CCT, 10s-CCT, and change in CCT within 10 s are 33.14 ± 1.02°C, 32.90 ± 0.99°C, and 0.23 ± 0.20°C, respectively. Except for the initial CCT (p = 0.549), significant differences are observed in the 10s-CCT (p = 0.034) and the change in CCT within 10 s (p < 0.001) between the two groups. The standard deviation of the temperature values within the region of interest (SD of TVs within ROI) on the central cornea is calculated to compare the uniformity of corneal temperature. In the DED group, the mean standard deviation of the initial temperature values within the region of interest (SD of initial TVs within ROI) is similar to that in the control group (0.23 ± 0.07°C vs. 0.22 ± 0.05°C, p = 0.926). In contrast, the mean standard deviation of the tenth-second temperature values within the region of interest (SD of 10s-TVs within ROI) in the DED group is greater than that in the control group, and there is a significant difference (0.44 ± 0.20°C vs. 0.35 ± 0.15°C, p = 0.016). In the DED group, the mean change in CCT within 3 s after tear film break-up is significantly greater than that before tear film break-up (0.19 ± 0.08°C vs. 0.10 ± 0.10°C, p < 0.001). As the time with eyes open increases, dry eyes present a significantly faster decrease in central corneal temperature (CCT) and a significantly worse uniformity of corneal temperature compared with normal eyes.

Bioequivalence of Preservative-free and Preserved Omidenepag Isopropyl (OMDI) 0.002% Ophthalmic Solutions in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: Results from the Phase 3 DAISY Study.

Preservative-free omidenepag isopropyl (OMDI) 0.002% ophthalmic solution and OMDI 0.002% ophthalmic solution preserved with benzalkonium chloride were bioequivalent in lowering intraocular pressure after 4 weeks' treatment in patients with primary open-angle glaucoma or ocular hypertension. Preservatives in ophthalmic solutions for lowering intraocular pressure (IOP) are associated with ocular surface disease. The DAISY study evaluated the bioequivalence of preservative-free omidenepag isopropyl (OMDI) 0.002% ophthalmic solution (DE-117B), with OMDI 0.002% preserved with benzalkonium chloride (BAK). DAISY was a phase 3, randomized, evaluator-masked, crossover study conducted in Japan. Patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) were randomized 1:1 to DE-117B or OMDI 0.002% for 4 weeks (period 1) then crossed over for 4 weeks (period 2). A 4-week washout preceded both periods. The primary efficacy endpoint was mean diurnal (MD) IOP at Week 4 (combined periods 1 and 2). Bioequivalence between DE-117B and OMDI was defined as 95% confidence interval (CI) between -1.5 and 1.5 for least-squares (LS) mean between-group difference in MD IOP. Adverse events were monitored. Of 74 patients enrolled, 38 were randomized to DE-117B then OMDI, and 36 were randomized to OMDI then DE-117B. DE-117B and OMDI demonstrated bioequivalence at Week 4 (MD IOP±standard deviation in summary statistics: 17.76±2.05mm Hg [DE-117B] vs. 17.71±2.01mm Hg [OMDI]; LS mean±standard error between-group difference in linear mixed effects model: -0.02±0.18mm Hg [95% CI -0.38 to 0.35]). DE-117B versus OMDI was associated with numerically lower overall ocular discomfort. Preservative-free DE-117B and BAK-containing OMDI were bioequivalent in lowering IOP after 4 weeks' treatment in Japanese patients with POAG or OHT. DE-117B was well tolerated with a similar safety profile to OMDI.

ASSESSING THE IMPACT OF LEVATOR RESECTION BY ANTERIOR APPROACH WITH AND WITHOUT UPPER LID BLEPHAROPLASTY ON DRY EYE SYNDROME

Background: Dry eye disease is a multifactorial condition that significantly affects tear film homeostasis, resulting in ocular discomfort and surface damage. Surgical interventions like upper eyelid blepharoplasty, often performed for aesthetic and functional purposes, can disrupt the tear film, particularly when combined with levator resection. Understanding the impact of these procedures on dry eye parameters is crucial for optimizing patient outcomes, especially in populations predisposed to dry eye symptoms due to age or other risk factors. Objective: To evaluate and compare the effects of upper eyelid blepharoplasty with levator resection versus levator resection alone on dry eye parameters, focusing on tear film stability and subjective symptoms. Methods: This prospective study included 120 eyes from 120 patients diagnosed with acquired ptosis, equally divided into two groups: one undergoing upper eyelid blepharoplasty combined with levator resection and the other undergoing levator resection alone. Dry eye parameters, including tear break-up time (TBUT), Schirmer's test, and Ocular Surface Disease Index (OSDI) scores, were assessed preoperatively, and at 1 and 3 months postoperatively. The surgeries were performed under local anesthesia, and postoperative evaluations excluded the use of lubricants to ensure unbiased tear film assessments. Results: In the blepharoplasty with levator resection group, the mean preoperative TBUT decreased from 15.27 ± 2.62 seconds to 14.32 ± 2.89 seconds at 1 month, followed by partial recovery to 14.87 ± 2.72 seconds at 3 months. Schirmer’s test values dropped from 14.88 ± 2.12 mm preoperatively to 13.87 ± 2.29 mm at 1 month, improving to 14.60 ± 2.13 mm at 3 months. The OSDI score increased from 48.05 ± 19.12 preoperatively to 48.95 ± 19.24 at 1 month and improved to 46.55 ± 19.13 at 3 months. In contrast, the levator resection alone group showed stable dry eye parameters, with preoperative TBUT, Schirmer’s test, and OSDI scores remaining consistent at 1 and 3 months. Conclusion: Upper eyelid blepharoplasty with levator resection temporarily exacerbates dry eye symptoms and reduces tear film stability, with partial recovery by 3 months. Levator resection alone did not significantly impact dry eye parameters, underscoring the role of blepharoplasty-specific interventions in these changes. Proactive patient counseling and early postoperative management are essential for mitigating transient discomfort.

Meibomian gland alterations in allergic conjunctivitis: insights from a novel quantitative analysis algorithm.

To investigate the changes in meibomian gland (MG) structure in allergic conjunctivitis (AC) patients using an intelligent quantitative analysis algorithm and to explore the relationship between these changes and clinical parameters. A total of 252 eyes from patients with AC and 200 eyes from normal controls were examined. Infrared meibography was performed using the non-contact mode of the Keratograph 5M. MG images were analyzed using a deep learning-based a quantitative analysis algorithm to evaluate gland length, area, dropout ratio, and deformation. Clinical parameters, including tear meniscus height, tear break up time (TBUT), conjunctival hyperemia, and Ocular Surface Disease Index (OSDI) scores, were assessed and correlated with changes in the structure of MG. The average MG length in AC patients was 4.48 ± 1.04mm, shorter compared to the control group (4.72 ± 0.94mm). The average length of the central 5 glands in AC patients was 4.94 ± 1.67mm, which was also shorter than the control group's central 5 glands (5.38 ± 1.42mm). Furthermore, the central 5 glands' area in AC patients (1.61 ± 0.64mm2) was reduced compared to the control group (1.79 ± 0.62mm2). Tear meniscus height was lower in the allergy group (0.26 ± 0.10mm) compared to the control group (0.44 ± 0.08mm) (P < 0.05). The non-invasive first tear film break-up time was shorter in the allergy group (8.65 ± 6.31s) than in the control group (10.48 ± 2.58s) (P < 0.05). Conjunctival congestion was higher in the allergy group (1.1 ± 0.52) compared to the control group (0.97 ± 0.30) (P < 0.05). The OSDI score in the allergy group (8.33 ± 7.6) was higher than that in the control group (4.00 ± 0.50) (P < 0.05). Correlation analysis revealed that the gland dropout ratio was positively associated with male gender and negatively associated with age and OSDI scores. Additionally, despite an increased number of MG, tear film stability was not improved. Through the intelligent quantitative algorithm, we found that AC leads to significant changes in MG structure, particularly affecting gland length and central area.